Yesterday morning I was on my way to my second call shift of the semester. The man got up to take me at 6:45am. I got in the car and put my head back to take a two minute nap. I was so, so tired because I had stayed up most of the night trying to prepare for clinical (making sure I had what I thought I needed, reading up, filling out my brain book, and making some cheat sheet flashcards) I wish I had've remembered to look in the guide they gave us which told us what to bring because I stilll didn't have everything. As we pulled off from the house, Brittany's tribute song came on the radio. It's been 20 days.
I was given report by the student midwife who had worked the 7pm-7am shift, and then went to meet the laboring woman. When I walked into the room I recognized her, and I was so grateful because I really hate how we work with women in labor and birth without ever having met them, but this woman had worked a shift with me on my pediatric rotation. When I got to the room she was 7cms and working hard. The father of the baby and her sister were there, but the sister was youngish (16?) and very pregnant and just there to "see how it is." But her guy, he was present and supportive.
S.A. is 27, and has 2 baby girls at home. She had epidurals and lacerations & tears requiring stitches with her first two babies. She had went from 3cm to 7cms dilated in less than two hours, and this was 30minutes later and she was grunting. So, when she asked about an epidural we explained the possibility of it not taking affect quick enough for how fast she was moving "You're about to have the baby," we were saying.
She looked at me and said "I've never done it this way - never without an epidural."
Me: "I know, but you can."
Her: How do you know?
Me: Because I believe you're strong.
Her: But I...I...I
Me: You got this. We're here. We're all here for you.
Her: No, you don't understand, I can't do this! (transition kicked in with...trembling...crying...hot flashes)
Me: You're doing it! You're at the end, this is it, you're so amazing!
This is about where my friend who was 2nd call came in to help with labor support, which was awesome because she was needing all the encouragement she could get, plus a little shocked that she was going to have the baby without pain meds! And I was needing to refocus down below since I really had very little clue what I was doing LMAO. When you're learning it's hard to do both the eye to eye personal attention and the physical work.
Then her body began involuntary pushing and she grunted "it's coming." When women who have had children already say this, it's usually true! And their babies can come out pretty fast. So that was my cue to gown up (gown, gloves, mask). She had an anterior lip of the cervix left, so we got her to lay on her side with her leg up (held by the nurse) and she ended up loving that position and wanting to stay that way for the remainder of the time. The only concern I had was her hemorrhoids...the worst case I had ever, ever seen before. Even my preceptor was a little worried at the size of them. She tried to apply counterpressure while she pushed, but she said that didn't help at all, so my preceptor abandoned the attempt and we just kept an eye on them.
Then the screaming began.
Crowning.
A forehead, a nose, fat cheeks, lips, and a chin - very slowly as to prevent tearing. The anterior shoulder, posterior shoulder, and the rest of baby's body.
A cord wrapped once around the neck and then once around a foot. Baby straight to mama's belly, UNpulsating cord cut by the daddy.
Yesterday, on February 9, 2008, I caught my first baby.
I welcomed a person, a girlchild, into the world with my own two hands. I saw a person open their eyes for the first time on earth....take their first breath.
And one more thing...four little words: over an intact perineum.
I'm still a little dazed.
Sunday, February 10, 2008
Friday, February 8, 2008
Wednesday, February 6, 2008
Midwifery Prenatal Clinic Rotation
I started clinical last week. I have two half days of antepartum (prenatal) clinical, and usually just one intrapartum call shift (labor and birth). For the sake of continuity and detail (and keeping with the purpose of this blog) here's what my morning of clinical was like today:
6:30/7am-Up and out the house to get to the medical campus. My clinical site is the free-ish clinic associated with the university hospital. WIC and social work are on site, which is great, especially for this population. I am supposed to arrive at 8:30, the first patient isn't until 9...but I have to look up all the patients first (ie: review their charts which, depending on how long they've been coming to the clinic, can be miles and miles long) Usually, previously, we had been able to do this step the night before at school in the computer lab, but the system is down...so I had to go to clinic early to get the info. Not fun. Know what else sucks? Half the patients will not show up...so I will end up doing half of it for nothing! *sigh* Sometimes I wing it, without looking up the patient first, but rarely, because I don't like walking into the room cold. It's bad enough that the woman already sees so many providers for her care, the least I can do is know *something* about her before I, yet another person, comes trembling in.
8:55am: My preceptor comes in to the charting room, and I give her this spiel:
"X is a 27yo G4P3003 LMP(last menstrual period) 8/1/2007 EDD(expected due date) 5/9/2008 by LMP EGA 26+5 here for her initial OB appointment. My plan today is to do a full history and physical exam, including pelvic with pap, G&C (gonorrhea and chlamydia), and pelvimetry, also FHT (fetal heart tones...ie listen to the baby's heartbeat) and Leopold's. She needs an HIV consent form, her blood drawn, a urine sample, a prescription for vitamins, and a 1hr GTT. Counseling will include nutrition, safety, and referral to WIC if appropriate."
-------------> Yes I practice this spiel...and they drill it into our heads at school.
Preceptor: What's going to be one of the most important things you do physically today since she hasn't had an ultrasound?
Me: Make sure the EGA I get by physical exam matches up with her EDD based on LMP?
Her: Yep. You got it. Are you really going to go through pelvimetry?
Me: Uhhhhnnnn no???
Her: Why not?
Me: Mmmm cause she's already given birth to 3 babies?
Her: Yeah, and were they vaginal deliveries and what size were the babies?
Me: (consulting my cheat sheet from reviewing her chart-----> and this is why you review the charts first!) 7lbs9oz, 8lbs3oz, and 8lbs1oz, all vaginal.
Her: Uh huh, meaning her pelvis is probably plenty adequate and pelvimetery can be uncomfortable! Come get me if you need me.
Then I go into the room and call the interpreter because the woman only speaks Spanish and we have an appointment with an interpreter on speaker phone. I do the exam, and, per usual, get stuck with leopold's, but everything else, including her fundus being at about the umbilicus (belly button) which is about right for her dates. So then I have to get the preceptor to help me with leopold's, and we're done.
Right now, leopold's is one of the hardest skills for me. I never, ever push in hard enough with my hands! Especially for Pawlick's grip...I hate that one...
I had 4 patients this morning. They all went about like the one above, but there's always something I end up needing help with of course. Today it was the following:
1. Couldn't find FHT for one woman: Normally, you find the fetal back and put the dop tone there, but if you have no idea where the back is (cuz your leopold's maneuvers aren't very food yet ;o) then I suggest you start with the LLQ on the woman, then start moving medially and superiorly. Also, you have to push a little harder than you think...it's doesn't work with light surface touch! Lastly, don't forget to change the angle of the wand (ie: the position you're holding it in) sometimes it won't pick up in a direct vertical angle, but if you lessen the angle a little bit you'll find it.
2. Stumbled all over the GBS explanation. Yes we learned this already in class, and yes I knew what it was...but I was trying to figure out how to explain in plain terms, and got tongue twisted. But I suggest you write out a little 3 sentence explanation of what it is and why we're testing for it, and MEMORIZE it so it's on the tip of your tongue always! I guess I could say the same for the Rh conversation...
All of the women today were past 20weeks, so I didn't have to do the bimanual sizing of the uterus, but I usually have a hard time with that, too. I couldn't tell you anterior from posterior if I tried...I did assess retroflex the other day though...
After that I go and do my own charting if I didn't complete it in the room, which I often don't because I prefer to actually be looking at the woman as we're talking instead of reading the screen and clicking yes or no as she answers...but I know that this is the luxury of being a new student with 4 patients instead of 15 for the day and that this might go out the window when my load increases...but I'll enjoy it for now!
EDIT to ADD: MISPRINT! Fundus at umbilicus = 20weeks...if her fundus was at her belly button at 27weeks she would NOT be "size equal to dates" I probably have two patients confused!
6:30/7am-Up and out the house to get to the medical campus. My clinical site is the free-ish clinic associated with the university hospital. WIC and social work are on site, which is great, especially for this population. I am supposed to arrive at 8:30, the first patient isn't until 9...but I have to look up all the patients first (ie: review their charts which, depending on how long they've been coming to the clinic, can be miles and miles long) Usually, previously, we had been able to do this step the night before at school in the computer lab, but the system is down...so I had to go to clinic early to get the info. Not fun. Know what else sucks? Half the patients will not show up...so I will end up doing half of it for nothing! *sigh* Sometimes I wing it, without looking up the patient first, but rarely, because I don't like walking into the room cold. It's bad enough that the woman already sees so many providers for her care, the least I can do is know *something* about her before I, yet another person, comes trembling in.
8:55am: My preceptor comes in to the charting room, and I give her this spiel:
"X is a 27yo G4P3003 LMP(last menstrual period) 8/1/2007 EDD(expected due date) 5/9/2008 by LMP EGA 26+5 here for her initial OB appointment. My plan today is to do a full history and physical exam, including pelvic with pap, G&C (gonorrhea and chlamydia), and pelvimetry, also FHT (fetal heart tones...ie listen to the baby's heartbeat) and Leopold's. She needs an HIV consent form, her blood drawn, a urine sample, a prescription for vitamins, and a 1hr GTT. Counseling will include nutrition, safety, and referral to WIC if appropriate."
-------------> Yes I practice this spiel...and they drill it into our heads at school.
Preceptor: What's going to be one of the most important things you do physically today since she hasn't had an ultrasound?
Me: Make sure the EGA I get by physical exam matches up with her EDD based on LMP?
Her: Yep. You got it. Are you really going to go through pelvimetry?
Me: Uhhhhnnnn no???
Her: Why not?
Me: Mmmm cause she's already given birth to 3 babies?
Her: Yeah, and were they vaginal deliveries and what size were the babies?
Me: (consulting my cheat sheet from reviewing her chart-----> and this is why you review the charts first!) 7lbs9oz, 8lbs3oz, and 8lbs1oz, all vaginal.
Her: Uh huh, meaning her pelvis is probably plenty adequate and pelvimetery can be uncomfortable! Come get me if you need me.
Then I go into the room and call the interpreter because the woman only speaks Spanish and we have an appointment with an interpreter on speaker phone. I do the exam, and, per usual, get stuck with leopold's, but everything else, including her fundus being at about the umbilicus (belly button) which is about right for her dates. So then I have to get the preceptor to help me with leopold's, and we're done.
Right now, leopold's is one of the hardest skills for me. I never, ever push in hard enough with my hands! Especially for Pawlick's grip...I hate that one...
I had 4 patients this morning. They all went about like the one above, but there's always something I end up needing help with of course. Today it was the following:
1. Couldn't find FHT for one woman: Normally, you find the fetal back and put the dop tone there, but if you have no idea where the back is (cuz your leopold's maneuvers aren't very food yet ;o) then I suggest you start with the LLQ on the woman, then start moving medially and superiorly. Also, you have to push a little harder than you think...it's doesn't work with light surface touch! Lastly, don't forget to change the angle of the wand (ie: the position you're holding it in) sometimes it won't pick up in a direct vertical angle, but if you lessen the angle a little bit you'll find it.
2. Stumbled all over the GBS explanation. Yes we learned this already in class, and yes I knew what it was...but I was trying to figure out how to explain in plain terms, and got tongue twisted. But I suggest you write out a little 3 sentence explanation of what it is and why we're testing for it, and MEMORIZE it so it's on the tip of your tongue always! I guess I could say the same for the Rh conversation...
All of the women today were past 20weeks, so I didn't have to do the bimanual sizing of the uterus, but I usually have a hard time with that, too. I couldn't tell you anterior from posterior if I tried...I did assess retroflex the other day though...
After that I go and do my own charting if I didn't complete it in the room, which I often don't because I prefer to actually be looking at the woman as we're talking instead of reading the screen and clicking yes or no as she answers...but I know that this is the luxury of being a new student with 4 patients instead of 15 for the day and that this might go out the window when my load increases...but I'll enjoy it for now!
EDIT to ADD: MISPRINT! Fundus at umbilicus = 20weeks...if her fundus was at her belly button at 27weeks she would NOT be "size equal to dates" I probably have two patients confused!
Monday, February 4, 2008
Facing the Possibility of Impeded Progress
Both my friend, K, and darkdaughta alluded to whether or not the institution would be receptive, or down right inhibitive, of my project because of the possibility of some ugly truth being brought to light about this business of educating black midwives...in other words, will their being angry (if that's what happens) stop me from progressing safely through the program?
Great question, especially from folks who care about my sanity.
The answer:
I have a one woman army right now. A black(?) dreadheaded PhD holding midwife who wrote her dissertation using phenomenological qualitative methods with a vulnerable population. There was a very long conversation, a lot of soul searching in her office...a lot of
After that *** stopped by because she said she had to see what was so funny cause we were "so loud" and my army, she said,
The point is, I think it will be ok. You can never know these things until you're in the middle of them. But what I do know is that I can not settle for anything less than a thesis...I tried, I couldn't do it. My personal standards did not allow it. What I also know is I am done...absolutely f.i.n.i.s.h.e.d. with researching things that other people find worthy but mean very little to me. $100,000 buys me the right to write about whatever I choose. This is easier to say because I have a supportive advisor, and a conscious black feminist dean who has the power to make sure I am not denied my degree/progress based on beaurocratic BS or privileged ego tripping. They're all crazy. Academics. But so am I. There's no seperating myself from them. But I think that if it should go down elsewhere in the cog...they will very quickly realize that it would be...easier...safer...to leave me the hell alone, than it is to have me still enrolled a year later.
(Guffawing, I am. LOL)
But in all seriousness, I asked about this. She (my advisor) was confident in her ability to lead the way through the institution and this process, and I, as a result, feel more at ease...or at least supported. And, it helps that the only person who has to sign off on my thesis as a completed work - meeting all requirements for graduation- is my advisor...yeah, that makes a big difference.
There's no turning back.
Great question, especially from folks who care about my sanity.
The answer:
I have a one woman army right now. A black(?) dreadheaded PhD holding midwife who wrote her dissertation using phenomenological qualitative methods with a vulnerable population. There was a very long conversation, a lot of soul searching in her office...a lot of
"why I'm here, right now, while you're here....there is a reason, I think we've found it, or one of many...I am more than cable of walking you through and being extremely supportive of this process. I've done this, I know how to do it, and I will get you through it."
After that *** stopped by because she said she had to see what was so funny cause we were "so loud" and my army, she said,
"well since you stopped by I think it's the perfect time to let you know what we're going to do."She was so sure, so confident. Take no prisoners. She explained it, I just sat there.
The point is, I think it will be ok. You can never know these things until you're in the middle of them. But what I do know is that I can not settle for anything less than a thesis...I tried, I couldn't do it. My personal standards did not allow it. What I also know is I am done...absolutely f.i.n.i.s.h.e.d. with researching things that other people find worthy but mean very little to me. $100,000 buys me the right to write about whatever I choose. This is easier to say because I have a supportive advisor, and a conscious black feminist dean who has the power to make sure I am not denied my degree/progress based on beaurocratic BS or privileged ego tripping. They're all crazy. Academics. But so am I. There's no seperating myself from them. But I think that if it should go down elsewhere in the cog...they will very quickly realize that it would be...easier...safer...to leave me the hell alone, than it is to have me still enrolled a year later.
(Guffawing, I am. LOL)
But in all seriousness, I asked about this. She (my advisor) was confident in her ability to lead the way through the institution and this process, and I, as a result, feel more at ease...or at least supported. And, it helps that the only person who has to sign off on my thesis as a completed work - meeting all requirements for graduation- is my advisor...yeah, that makes a big difference.
There's no turning back.
Sunday, February 3, 2008
Information Overload + THESIS
School started about three weeks ago, but it feels like months. There was so much information given in that time of 8 to 10 hour days, lecture upon lecture upon lecture. I am having a hard time organizing the information and all the texts we use, not to mention the articles and online resources. Just when I think I've found the text that I like (Oxorn and Foote), a professor asks me something that I don't have an answer for and someone says, "oh, that was in Varney." Varney is so comprehensive that it's hard to read. I fall asleep on it if I'm not uberconcentrated. I'm working on my midwifery black book that we have to have with us at clinical (both prenatal and labor and birth) and that's taking up a huge amount of time to fill in. (I just bought a new one, my permanent one, it took me a whole semester and a half to find it...I'm anal about these things) I'm going to post some stuff here, trying to get myself together...this is just for now through Tuesday night...
:: 2 appointments to set this week:
1-NCLEX discussion with director of program, per her request
2-Required adviser appointment, where I also plan to discuss IRB process with her since she happens to be on the committee for the school
:: Study for Pharm quiz tomorrow: over chapters 4,5,&6 and the lecture from 1/28
:: Finish prenatal pages in black book, up to current lecture (about 10 pages left), including charting examples!
:: Start Intraprtum pages in black book (goal of 15 pages by Saturday, maybe?)
:: Finish chapter 21 and 22 in Varney (UM...pay attention...hardest thing on the list...lol)
:: Problem Statement for Research class (hmm...I should really get started on this ASAP...)
Review my patients clinical Wednesday morning...which means I have to *find* a way to do this because the system is not up and working at school yet, but they will not care about that...*sigh*
In other (very important) news... my praxis is finalized, advisor secured, emotional roller coaster of making a decision finally over, first advising appointment completed, and second one scheduled with a LOT of work to do in between, I am officially announcing my thesis question:
What are the lived experiences of Black/African American midwifery students in graduate nursing programs? (A Phenomenological Qualitative Study)
Yes, I'm crazy...
But I'm also committed...somebody has to tell it.
:: 2 appointments to set this week:
1-NCLEX discussion with director of program, per her request
2-Required adviser appointment, where I also plan to discuss IRB process with her since she happens to be on the committee for the school
:: Study for Pharm quiz tomorrow: over chapters 4,5,&6 and the lecture from 1/28
:: Finish prenatal pages in black book, up to current lecture (about 10 pages left), including charting examples!
:: Start Intraprtum pages in black book (goal of 15 pages by Saturday, maybe?)
:: Finish chapter 21 and 22 in Varney (UM...pay attention...hardest thing on the list...lol)
:: Problem Statement for Research class (hmm...I should really get started on this ASAP...)
Review my patients clinical Wednesday morning...which means I have to *find* a way to do this because the system is not up and working at school yet, but they will not care about that...*sigh*
In other (very important) news... my praxis is finalized, advisor secured, emotional roller coaster of making a decision finally over, first advising appointment completed, and second one scheduled with a LOT of work to do in between, I am officially announcing my thesis question:
What are the lived experiences of Black/African American midwifery students in graduate nursing programs? (A Phenomenological Qualitative Study)
Yes, I'm crazy...
But I'm also committed...somebody has to tell it.
Saturday, February 2, 2008
Ruminations...Life and Love...cont.
Continuing with my last post, because that's where I am right now, now matter what else is going on, what I know as truth for me is that what I call love is what keeps my world spinning, it is why I get up in the morning. Not just now, but it has always been.
Wednesday, January 30, 2008
Coming Out from Under
I'm home, from home. It was good to go and be surrounded by people who understood the enormity of the hole that is left in the world. Brittany Williamswas joy,
personified. To be home was to be in a place where my "I don't understand" did not echo back on itself. It was good to have coffee, and hug my baby, and sit with my grandma, be with my parents. Yes, it was good to be home.
I can not begin to explain it...what it feels like to see so many young people in a funeral parlor. Many of them desensitized because it's not the first time. Nor will it be the last. Who can blame them for talking about something else, anything else? It's crushing and heavy and suffocating. I was so hot. So, so, hot. There were so many people that the wake was basically done in shifts to keep people from having to be outside, which meant that I couldn't even stay as long as I wanted to, needed to. The funeral was held elsewhere to accommodate the community. But I did get to speak to her mother, which was really something that I needed to do. I kept thinking I can't leave here without seeing her, saying something. When I finally made it I didn't get to say anything, she said everything:
Oh my god, it's you. She loved you. She talked about you always. She never stopped talking about you. She looked up to you. She loved you. She loved you.
"I'm so, so sorry" was all I could manage. But I'm looking for a card, actually, a post card, to send her a very simple note of what a difference her daughter made in my life, too.
What her mother said to me that day is on my mind. I started to think about whether or not what I've done with my life is enough. The answer is yes. YES. I know I'm young to be saying so, but I realized over the weekend that if I knew I were to die tomorrow, I could (outside of initial human shock) be at peace with that. I have loved, hard. I have given without expectation, I have shared my last. I have honored those to whom I owe my existence. I have been a friend. A real friend. And I have spent time thinking critically of my life, what I want, and what I have to give.
And this week or the next, during one of my first call shifts, I will have ushered life into the world, safely (please dear God, safely).
In keeping with humanness, I am flawed, of course. But I am happy with my contribution to the universe. Everyone that I love and cherish, knows it. If I never do another thing, I did enough. I just want people to know that, because one day you're here, the next you're not.
One moment she was here, the next she was gone.
I sit with that all day. I pray for her, and her mother, and the rest of us. I try not to look at pictures too often, and lately I've been avoiding the song used for her tribute. I am building back up my armor because there is just no way to keep this pace, and this work load, without it, and I am vulnerable here. I don't know these people, even though they think they know me. Right now I'm sticking to the two or three people that I know have my back, and that's enough. And of course, the man. Those who are far away, please call. Don't let my schedule deter you. I'll call more, too. Who are we, and what do we think we're doing, otherwise?
What I know now for sure, that I was only saying before is this: we've got it all wrong.
If you don't give love, fully, thoroughly, then you're lost. I'm sure. If you can not think of one person who you love no matter what the hell they do or say or know or don't know or look like...one person whose life you find yourself directly responsible for, you've got work to do. Please don't confuse this with marriage or a boyfriend or a girlfriend, or any other label you can think up. No labels allowed. Just love. Unwavering, unconditional, love. The kind that says I am happy that you exist....I will be the person who thinks of you before I lay down my own head at night...I will leave the porch light on for you, even if only theoretically...I gotchu...I'm here, to the best of my ability...I'll remember you, when you're gone...if there's nobody else, there will always be me, in body or spirit. Love. That's it.
That's the answer.
Thank you all for leaving your well wishes. Thanks for reaching out. Thanks for reading.
I'm coming out from under.
Wednesday, January 23, 2008
Going Home
Life is fuzzy right now. I've built up enough reserve, enough cover, enough armor to go through the day without crying. I hate crying in front of people I don't trust, so that was important today. My life is different. I just feel like this is it. This is all we have. It is our responsibility to live this, the only life we have, to our fullest potential...and I don't mean potential as defined by someone else...I mean living one's life to the fullest of their own standards and definitions. This is all we get. This is it. There were things I believed in yesterday that I no longer believe in today...like giving my time away to people who I genuinely don't want to be around.
I'm headed home for the weekend on Friday.
So much is happening...
They're calling it "premeditated, but random."
That's hard.
They're saying he had already reloaded his rifle for his next shot, calling him a sniper.
That's so...sad.
"On behalf of the entire Bormann family, we would like to extend our sincerest condolences to the family and friends of Brittany Williams," an e-mail to the station said. "We do not understand why this happened, as we are still trying to figure it out for ourselves. We would also like to extend our sincerest apologies and regrets. We understand that there are absolutely no words that can change what happened in this tragic event and would like Brittany's family to know that they are in our thoughts and prayers every hour of every day."
You'd have to know something about Omaha...about this place of Malcolm X's birth and raising. I only mention him because when people think of why he was so...angry...I don't think they can understand that without knowing about where he came from...where I come from.
That's what I was saying, too.
I kept saying, "my Brittany? Brittany, Brittany?"
I'm going home.
Tuesday, January 22, 2008
A Very Long Night
I surfed the net, and cried.Watched the MySpace AKA Tribute over and over again and cried.
Ate dinner, and cried.
Did homework, and cried.
Tried to watch tv, and cried.
Looked at pictures, and cried, and cried, and cried.
Watched the news videos and cried and cried and cried and cried.
I don't know. I just don't get it. I know there's nothing to get. I know it doesn't make sense. I know that time heals people. I know that even when the child you lose is the only one you had, there is still life somewhere within you...but I can't see it. I wonder how her parents continue to breathe. How the sun keeps shining. How the world keeps turning, how we, as people, keep trudging along...filling gaps in time, years of our lives, with mundane tasks...giving so much time to people we don't know, don't even particularly care for...in a race...to get to where? To buy the biggest house, the best material goods...trying to escape something...escape feeling something...we've got it all wrong. I don't know what it's supposed to be, what my everyday is supposed to be...but it aint this...the women, the people, their children, yes, but the rest...I don't know. Again, I'm far away. So very far away. My life is a series of tasks, each one seems even more meaningless than the last. In the absence of being surrounded by the rest of community that knew her, loved her, I am stuck in this fog by myself, remembering.
Remembering study group...10pm...11pm...midnight Starbucks run...1am...trying to memorize the bones, muscles, and blood flow of the human body
Remembering us at Buffalo Wind Wings on Tuesday nights...us at Chipotle for study break...us closing down the library, moving to the computer lab...us making Ramen Noodles in the cafeteria before it closed for the night...
Remembering trying to convince her to get rid of her gold and diamond grillz and super duper nails-"you gotta get a more professional hair style, too, Brittany...yes, wear a suit...no, not a green one..." before her nursing school interviews...me doing mock interviews over the phone with her for two nights before her interviews...her calling me at the interviews, scared shitless...
Remembering lab...the dead cat...us trying to get through dissection, thinking why did we get in the same group...damn...now we have to touch it!
Remembering the purse party...she loved, LOVED, some purses...and the hair...omg, the hair...never a dull moment with that hair...endless conversations about...hair...
Remembering taking pictures after the Goodrich sophomore graduation...her and those pearls...rock it Brittany...
Remembering her arguing with Tory...fighting with Tory...beating down the apartment door trying to get to Tory...her loving, loving, loving Tory...always...
Remembering... Brittany Williams
Her saying, "you can't leave me...what am I supposed to do?"
Me saying, "you can do this without me, and you still have S and PB."
Her: [a long whine]
Me: "You'll live."
And then I came here. And we emailed and called, but mostly texted, and I tried to keep up because otherwise school is consuming. I don't talk to most people very often. I used to talk to my mama everyday, but now even that doesn't happen. I remember Brittany sent me a one liner email:
"Am I ever going to talk to you again?"
Then I tried to call or email more often. People matter to me. I am an emotional, people person, to those I know. I am distant, and hardly moved by those I don't. For me, without family and community, there is nothing else. So here I am, over a thousand miles away, trying to figure out how I got here, so far away from almost every person who means anything to me at all. How I manage to continue living this far away from friends and family, like Brittany. How today is a new day in the world, even though she's gone.
She's gone.
Just like that. One day you're here, the next you're not. One moment you're picking up food for your dad, trying to make his life easier, trying to do something nice for somebody else...the next moment you're gone.
She's gone.
But I can see her. I can hear her voice. But she's not here...it's...unreal.
She's gone.
She's gone.
Monday, January 21, 2008
Sunday, January 20, 2008
Coffe, Drinks, and Conversation
A while ago I posted that I had went had drinks as a wind down/detox with my fellow black midwifery students and that the conversation was a little...dry. (see the last point of this post) Well, we tried again, the conversation was much better...much more personal...much more rewarding, for me at least.
I mentioned how I was saddened/concerned/frustrated with women's relationships right now. I said that I thought homophobia was one reason why we're so stagnant and distant from eachother. How I wish I would have developed the kinds of relationships I had in high school with my male friends with some women friends. Even my closest female friends have not been as close, literally, as my male friends have been. I struggled to define I wanted, what i was talking about as they asked me to clarify. I used the analogy of how I saw a movie once where three or four married couples went on a yearly retreat to discuss their lives for that past year...their goals, what they needed from others, what they were missing, asking for advice, sharing their expertise, etc...but also that they took walks and cooked together in the mornings, at dinner together and, importantly, everyone's business was on the table for real, honest discussion. I want that, but with women, specifically. I think it's sad that women only hold hands if they're in an intimate relationship....best friends don't walk the down the street holding hands anymore. I think it's the same, or worse, for men...I'm thinking about how in some cultures men great eachother with kisses on the cheek, but not the men I know (or the women). How even our hugs are almost non-existent. Even that yearly ritual of cooking the holiday meal together is lost because now we all just show up individually with a prepared dish. It used to be that everyone met up in the morning and cooked together. I used to have this when I was very very little because I was very close with my female cousins. We shared the laps of our parents, and especially grandmothers. We took baths together, in bathtubs and even sinks when we were small enough. And then we got older and of course that all that changed. But what also changed was the touch. I mean simple touch. Like when you were little and you whispered something to your girlfriend by putting your hand around her ear and you leaned into her ear to say it...remember that? Or when parents and grandparents use to hold your face in their hands when they spoke to you? We don't do that anymore. We used to smooth eachother's clothes, we used to put eachothers' hair in place....all lost arts, or diminishing. I have a few cousins who probably still interact this way with, but not many at all. And no women friends who I interact this way with. And we talked about how this affects birth, especially home birth because it's more personal. I thought about how I'd like to be surrounded by certain women at birth, but how that probably wont happen because how impersonal we are in real life will get in the way of the touch, and talk, and comfortableness we would be able to achieve in the birth environment. I also mentioned that when my friends was home with cervical cancer it would have so natural for me to bathe her, but how it would never work because she could not/would not allow it...it's such a vulnerable place...but women used to do this all the time, and in other parts of the world, and some underground parts of this world, they still do...what happened to us? One of my friends said that she thinks I will see at the black midwives conference this year because a lot of what I'm talking about still exists there (she went last year) they stand in a circle and hold hands, talking, sharing. They give eachother massages for the touch aspect, too.
I'm still thinking on this...
chime in wherever...
I mentioned how I was saddened/concerned/frustrated with women's relationships right now. I said that I thought homophobia was one reason why we're so stagnant and distant from eachother. How I wish I would have developed the kinds of relationships I had in high school with my male friends with some women friends. Even my closest female friends have not been as close, literally, as my male friends have been. I struggled to define I wanted, what i was talking about as they asked me to clarify. I used the analogy of how I saw a movie once where three or four married couples went on a yearly retreat to discuss their lives for that past year...their goals, what they needed from others, what they were missing, asking for advice, sharing their expertise, etc...but also that they took walks and cooked together in the mornings, at dinner together and, importantly, everyone's business was on the table for real, honest discussion. I want that, but with women, specifically. I think it's sad that women only hold hands if they're in an intimate relationship....best friends don't walk the down the street holding hands anymore. I think it's the same, or worse, for men...I'm thinking about how in some cultures men great eachother with kisses on the cheek, but not the men I know (or the women). How even our hugs are almost non-existent. Even that yearly ritual of cooking the holiday meal together is lost because now we all just show up individually with a prepared dish. It used to be that everyone met up in the morning and cooked together. I used to have this when I was very very little because I was very close with my female cousins. We shared the laps of our parents, and especially grandmothers. We took baths together, in bathtubs and even sinks when we were small enough. And then we got older and of course that all that changed. But what also changed was the touch. I mean simple touch. Like when you were little and you whispered something to your girlfriend by putting your hand around her ear and you leaned into her ear to say it...remember that? Or when parents and grandparents use to hold your face in their hands when they spoke to you? We don't do that anymore. We used to smooth eachother's clothes, we used to put eachothers' hair in place....all lost arts, or diminishing. I have a few cousins who probably still interact this way with, but not many at all. And no women friends who I interact this way with. And we talked about how this affects birth, especially home birth because it's more personal. I thought about how I'd like to be surrounded by certain women at birth, but how that probably wont happen because how impersonal we are in real life will get in the way of the touch, and talk, and comfortableness we would be able to achieve in the birth environment. I also mentioned that when my friends was home with cervical cancer it would have so natural for me to bathe her, but how it would never work because she could not/would not allow it...it's such a vulnerable place...but women used to do this all the time, and in other parts of the world, and some underground parts of this world, they still do...what happened to us? One of my friends said that she thinks I will see at the black midwives conference this year because a lot of what I'm talking about still exists there (she went last year) they stand in a circle and hold hands, talking, sharing. They give eachother massages for the touch aspect, too.
I'm still thinking on this...
chime in wherever...
Voices of Diversity in Midwifery
As I'm narrowing down my thesis topic (which I thought I had, but then ran into all kinds of roadblocks with my advisor, whom I trust) I read an article from the Journal of Midwifery and Women's Health:
"Voices of Diversity in Midwifery: A Qualitative Research Study"
by Kennedy, Erickson-Owens, and Davis.
I'd provide links to the articles but I know they wouldn't work because they're connected to university server access and all kinds of codes are required...the whole knowledge is only for the privileged, *sigh.*
Anyway, from the article:
"No studies have examined perspectives of midwifery practices from midwives who represent racial, ethnic, or gender diversity."
"...by listening to the voices of diverse midwives, we help to ensure that the characteristics of the midwifery model of care are not limited to the exclusive views of the predominantly white women of the profession."
...they should have added that the model is also very influenced by the fact that not all kinds of midwives are allowed to join the ACNM and so it is also narrow in that way...
One of the things that informed my choice of a research topic was this:
"Several described their own difficult student years where they had to struggle with the challenges of nonwhite status and language barriers."
Then, from one of the participants in the study, further explanation:
According to the authors: "The sense of invisibility went very deep, enough that one participant believed it could affect her viscerally, even when, intellectually, she knew the fault did not lie with here.
The participant said:
This grabbed a hold of me because the participants in this study had graduated from a range of 7 to 40 years ago...and still they're thinking about, talking about, what happened to them in midwifery school. Since I'm dead in the middle of it, I know what the hell is going on, and how...hard...this is, but it's hard to get other people to understand it. I think this point, that they're still thinking about it, is one way to say, look, this is not a game...I am not just a moody pisces...this is not oversensitive me...me who just doesn't want to go to the potluck...this is me who is consciously trying to limit my exposure to this stuff...stuff that you are so oblivious to...stuff that isn't good for me...
And so I decided that this was what I wanted to do my thesis on:
What are the lived experiences of black american students in nurse-midwifery programs?
I presented it in research class and it was fine, but then I met with my thesis advisor over break and she had a lot to say. Mainly, that this is actually a dissertation topic because of the lack of research already existing about it. Her position is that a master's level thesis expands on a topic that has already been researched, while a dissertation presents something totally new...which is what my topic is...maybe. So we talked about doing a literature review, but couldn't find any articles so far that could be reviewed. *sigh* We talked about how we would need IRB approval to do the project because I'd be interviewing people, and how that IRB approval would have to be applied for at all the schools whose student I would interview. And about how they only gave us 12 months to write the thesis, and how I'm school for most of that time. All of this to say, this topic is probably not going to happen...and all I could think about was "and this is how they do it...this is why the research is so few and far between...these are the gatekeepers to what gets written...why what the hell is happening in midwifery, nurse midwifery, is happening in secret, in quiet behind closed doors, when it comes to race and diversity. This is why I feel like I'm losing my mind alone despite the fact that most students of color felt this way when they were going through grad school...because not enough people are asking the questions and writing down the answers.
One day I got an email from my friend/mentor/life guide (that's a new on for ya, H ;o) about those posts I had been consumed with about losing my mind and spiraling into descent. She emailed back this quote from Where We Stand: Class Matters by bell hooks:
H also said: Your struggle is classic and enduring. You are not the first; you are not the last. You are not alone.
Someone has to ask us students the questions so that we can write down the answers so that those coming after us don't feel like...well, they'll probably still feel like it, but so they know that they aren't losing their minds...
The article was good, I had questions afterwards, which is to be expected, but overall, it was good to read the words of some non white midwives...
"Voices of Diversity in Midwifery: A Qualitative Research Study"
by Kennedy, Erickson-Owens, and Davis.
Abstract: The practice of midwifery reflects the spectrum of diversity among
midwives and the women they serve, yet the composition of midwives in ACNM does
not reflect the diversity of the women for whom they provide care. Providing
culturally appropriate care for women requires our best understanding of their
beliefs, needs, and desires; it also requires a wide range of diverse
clinicians. This study proposed to learn more about the practice of midwifery
from a diverse sample of midwives. A qualitative research design, which included
small group interviews, videotape collection of data, and content analysis, was
used. Four major themes were identified: 1) the worldview of midwifery through
the lens of diversity, 2) the experience of diversity, 3) midwifery strategies
rooted in diversity, and 4) the legacy for the profession of midwifery. There
must be purposeful action by every individual in the profession, as well as the
collective voice of midwifery, to identify barriers to inclusiveness and to
foster a culture of diversity through respect, recruitment, and mentoring.
I'd provide links to the articles but I know they wouldn't work because they're connected to university server access and all kinds of codes are required...the whole knowledge is only for the privileged, *sigh.*
Anyway, from the article:
"No studies have examined perspectives of midwifery practices from midwives who represent racial, ethnic, or gender diversity."
"...by listening to the voices of diverse midwives, we help to ensure that the characteristics of the midwifery model of care are not limited to the exclusive views of the predominantly white women of the profession."
...they should have added that the model is also very influenced by the fact that not all kinds of midwives are allowed to join the ACNM and so it is also narrow in that way...
One of the things that informed my choice of a research topic was this:
"Several described their own difficult student years where they had to struggle with the challenges of nonwhite status and language barriers."
Then, from one of the participants in the study, further explanation:
"So we're alone, because most of the time, we're just one or two. If we're
lucky, we have another colleague in the class. If not, we're by
ourselves. So it's very hard to find someone, another student to
collaborate with that would help you through school..."
According to the authors: "The sense of invisibility went very deep, enough that one participant believed it could affect her viscerally, even when, intellectually, she knew the fault did not lie with here.
The participant said:
'Yes, it's their problem, but it becomes your problem in a subtle way, that
there's a reaction in you when you are rendered invisible, like...a biochemical
reaction...that something happens to us when we're treated that way."
This grabbed a hold of me because the participants in this study had graduated from a range of 7 to 40 years ago...and still they're thinking about, talking about, what happened to them in midwifery school. Since I'm dead in the middle of it, I know what the hell is going on, and how...hard...this is, but it's hard to get other people to understand it. I think this point, that they're still thinking about it, is one way to say, look, this is not a game...I am not just a moody pisces...this is not oversensitive me...me who just doesn't want to go to the potluck...this is me who is consciously trying to limit my exposure to this stuff...stuff that you are so oblivious to...stuff that isn't good for me...
And so I decided that this was what I wanted to do my thesis on:
What are the lived experiences of black american students in nurse-midwifery programs?
I presented it in research class and it was fine, but then I met with my thesis advisor over break and she had a lot to say. Mainly, that this is actually a dissertation topic because of the lack of research already existing about it. Her position is that a master's level thesis expands on a topic that has already been researched, while a dissertation presents something totally new...which is what my topic is...maybe. So we talked about doing a literature review, but couldn't find any articles so far that could be reviewed. *sigh* We talked about how we would need IRB approval to do the project because I'd be interviewing people, and how that IRB approval would have to be applied for at all the schools whose student I would interview. And about how they only gave us 12 months to write the thesis, and how I'm school for most of that time. All of this to say, this topic is probably not going to happen...and all I could think about was "and this is how they do it...this is why the research is so few and far between...these are the gatekeepers to what gets written...why what the hell is happening in midwifery, nurse midwifery, is happening in secret, in quiet behind closed doors, when it comes to race and diversity. This is why I feel like I'm losing my mind alone despite the fact that most students of color felt this way when they were going through grad school...because not enough people are asking the questions and writing down the answers.
One day I got an email from my friend/mentor/life guide (that's a new on for ya, H ;o) about those posts I had been consumed with about losing my mind and spiraling into descent. She emailed back this quote from Where We Stand: Class Matters by bell hooks:
"Living in a world above the absolutes of law and man-made convention was
what any black person in their right mind needed to do if they wanted to keep a
hold on life. Letting white folks or anybody else control your mind and your
body, too, was a surefire way to fail in this life. That's what [her
grandmother] used to say--may as well kill yourself and be done with it."
H also said: Your struggle is classic and enduring. You are not the first; you are not the last. You are not alone.
Someone has to ask us students the questions so that we can write down the answers so that those coming after us don't feel like...well, they'll probably still feel like it, but so they know that they aren't losing their minds...
The article was good, I had questions afterwards, which is to be expected, but overall, it was good to read the words of some non white midwives...
Speaking of...
Class Privilege & Living Beyond Your Means...lol
The man and I are going to Paris for spring break.
We will actually stay in Malakoff, a city 3 miles from the center of Paris, at a bed and breakfast, but will of course travel catch the metro into Paris on most days.
No better way to count down the 7 weeks of the first half of the semester!
The man and I are going to Paris for spring break.
We will actually stay in Malakoff, a city 3 miles from the center of Paris, at a bed and breakfast, but will of course travel catch the metro into Paris on most days.
No better way to count down the 7 weeks of the first half of the semester!
Class Privilege Meme
You bold the ones that pertain to you.
2. Father finished college
32. Went on more than one cruise with your family
34. You were unaware of how much heating bills were for your family
1. Father went to college (Grambling "where everybody is somebody" State University, an HBCU in Louisiana, and then a state school, then the military) My other father went to college for a while, too.
3. Mother went to college (a secretarial trade school I think?)
4. Mother finished college
5. Have any relative who is an attorney, physician, or professor (I'm gonna say yes, based on professor...but I'm not sure...my family is huge, there's no way I could ever know...I have a cousin who's a pharmacist, though)
6. Were the same or higher class than your high school teachers
7. Had more than 50 books in your childhood home (dad's, plus library, plus my own, yes!)
8. Had more than 500 books in your childhood home
9. Were read children’s books by a parent
9. Were read children’s books by a parent
10. Had lessons of any kind before you turned 18
11. Had more than two kinds of lessons before you turned 18 (I took a lot of free classes...cooking, sewing, etiquette, clarinet, drama, sex ed, woodshop, pottery, art, computer...the list goes on forever...these were mostly taken at the community girls club where my mother works)
12. The people in the media who dress and talk like me are portrayed positively
13. Had a credit card with your name on it before you turned 18 (yep, my grandma made me an authorized user on her Kohl's department store card, which gave me a card with my name on it, LOL, when I was 16, I think)
14. Your parents (or a trust) paid for the majority of your college costs (paid for my own college...all of it)
15. Your parents (or a trust) paid for all of your college costs
16. Went to a private high school
17. Went to summer camp
18. Had a private tutor before you turned 18
19. Family vacations involved staying at hotels (yes, there were lots of those, whether we could afford it or not)
20. Your clothing was all bought new before you turned 18
21. Your parents bought you a car that was not a hand-me-down from them (bought my own vehicles, including the first)
22. There was original art in your house when you were a child
23. You and your family lived in a single family house (yes, and they still live in it, here it is...)
23. You and your family lived in a single family house (yes, and they still live in it, here it is...)
A whole 670 square feet! I came home to this house when I was born. This house is on a street that was filled with my family members. When I'm out in blogland reading what others write about family and love, I always come back to this place in my mind.
24. Your parent(s) owned their own house or apartment before you left home (no, they rent the home above, but they're working on saving up to buy something)
25. You had your own room as a child (yes, I was an only child, no one to share with)
26. You had a phone in your room before you turned 18
27. Participated in an SAT/ACT prep course (yep, found a free one!)
28. Had your own TV in your room in High School
29. Owned a mutual fund or IRA in High School or College
30. Flew anywhere on a commercial airline before you turned 16 (yep, including twice out of the US, to Europe)
31. Went on a cruise with your family (no, but after I got grown and moved out of the house, me and my mom went on two cruises!)
32. Went on more than one cruise with your family
34. You were unaware of how much heating bills were for your family
I think that's it for this meme in its original form. You can read dd's here or reSISTERence's here.
I put this up on my sight for a very specific reason. When you know very specific, limited things about a person, you really have no idea of their upbringing. Poor people have a habit of doing things, anything, to not look poor. You could be poor, but God forbid you looked or acted poor...meaning clothes dirty, half dressed for the weather, be the only one who couldn't afford the fieldtrip even though you really couldn't afford the field trip...ya know? There's also very little here about things other than the financial...other things that really go into defining class like the description of one's neighborhood, or the food commonly found in the refrigerator...do you buy sugar in 1 pound boxes, 2 or 4 pound bags, or 10 pound bags? Your health practices, dental work. Are there safe parks nearby, are you bussed to school. I'm surprised that this meme doesn't ask, were you on welfare? Using food stamps? How many relatives are in prison? Hell, was your father in prison? Did you get free lunch? Is it safe to be outside after the street lights some on? Do you often hear violence or gun shots or helicopters flying overhead? Is your neighborhood diverse? If you were not bussed, did every student have books at your school, or did you share? Have you participated in the section 8 housing voucher program? Are their metal detectors at your school? So much more could be asked. I think it's interesting where I fall on this meme. I bet my life experiences might be hard for people to reconcile with their idea of poverty. I think within the community people don't think much about why they have multiple phone lines and new cars but no IRAs or health insurance....
I tag a new blogger to do this: SOS midwifery Welcome to blogging!
Spring 2008 Week One, In Review
This first half is for future midwifery students to see what books we use, what classes, what skills we learned and how we learn new skills, and for those preparing to enter direct entry (ie:accelerated) NURSE-midwifery programs, the speed with which we are expected to learn these things...
First, let me say, I am exhausted.
But my class schedule this semester (the halfway point of the program) is better than last semester (thank you universe ;o):
Antepartum (prenatal care)
Intrapartum (labor and birth)/Postpartum
Advanced Pharmacology
Midwifery Pharmacology
Research Seminar
Main Midwifery Books this semester:
Varney's Midwifery
Human Labor and Birth (Oxorne & Foote)
William's Obstetrics
A Fetal Heart Monitoring Guide
Articles, articles, and more articles!
My schedule: Class two days a week (after intensives which is two-three weeks of all day classes five days a week), antepartum clinical two days a week (2 short days of prenatal clinics at the local community women's center - I LOVE my site!), and call once or twice per week! A heavy load, but exciting.
Skills learned this week:
Suturing (which I love, but of course hope I don’t have to do). Belly tales has a post about her first day of suturing, which describes the purpose and anxiety, and then she has an awesome pictorial post about the process of learning it. These are great posts so I don't feel the need to repeat. We also practiced on boneless, skinless chicken thighs to approximate flesh which is, of course, harder than foam! Also, she alluded to the items being provided for them...we had to buy everything. (The foam, chicken, instruments, and sutures...look for medical discount supplies online, and buy expired sutures which are much cheaper for practice. There is absolutely no need to buy expensive stuff because you will not be using these for anything other than practice - the hospital stocks the instruments, you can not bring your own!...But, of course, if you are going to be doing homebirthing, then YES you will need to buy good stuff since you'll be using it for more than practice...but hopefully not often) Along with suturing, you learn how to cut an episiotomy.
Venipuncture. They sprung this one on us. I was not amused. Maybe on Tuesday or so, she said “and Friday you will be learning to draw blood and start IVs…on eachother.” Ugh. Talk about anxiety. I managed to find the vein and poke my partner but as soon as I hit resistance, I pulled the needle right back out, scared, LOL. No IV insertion for me that day. In my defense though, my partner was so damn jumpy and nervous and tense. I did get blood flow though when I removed the needle, which means I was in the vein and that was enough for me. She did a stick on my hand, and it went fine despite the fact that I hated it.
Cardinal movements of labor. This was done with my partner and I taking turns being on the hospital bed, legs wide the hell open in lithotomy position with a fake baby on our bellies or under your shirt that you push out while she practices hand maneuvering and the teacher turns the baby's head to mimic the head positions of birth. She preferred for people to hold her legs back for her turn, I said just give me the stirrups for mine...that leg holding stuff is too intimate for me with people I don't really want all up in my space. Not the most fun activities this week, *sigh.* Now I will have to read the chapters and memorize the mechanisms (ie:cardinal movements) before my first day/night of call.
Vaginal exams. (sterile speculum exams, and how to check for dilatation in centimeters)
Leopold's Maneuvers. To determine size, position, etc. of baby inside the woman's pelvis. (Photo)
Fetal Scalp electrode. Where it goes, why we use it, and how to put it in...all demonstrated on a pelvis model.
Intrauterine catheter. Again, where, why, how.
Pudendal Block. When, where, how and why.
There's probably more, but I'm tired of talking about it. We also practiced sterile gowning and gloving for birth. The didactic content included everything that goes along with the above skills, and topics such as genetic counseling, intermittent auscultation guidelines, etc. A doula also came in to talk about her role as doula and about labor support techniques. It was a loooong week. And those were just the midwifery classes.
Now, on to other things...
One of the things that struck me this week was how medical midwifery education is for the CNM. Now, of course, this was not news to me, I researched all of this before selecting a program, and I'm well aware of the whole "medwife" thing floating around. But it's still...odd...how we learn midwifery in this setting...even knowing it would be medical, I am still shocked by just how medical it is. But more than that, it was a long week of frustration in terms of how we refuse to tell ourselves the truth about the kind of care we provide. For example: We were having a conversation about continuity of care. Continuity of care is simply the woman having the same provider for her whole pregnancy, or even including pre-conception, and her labor and birth and post partum check up. Our professor kept mentioning this continuity of care that we are providing as midwives. Eventually I had to ask (it was irking me) "is there a definition...a statement from the ACNM discussing the definition...of continuity of care that we are using to determine whether or not we are really providing continuity of care (COC)?" She didn't really answer that, but she re-iterated what COC was. So then I had to make a statement leading into another question: "As far as I've seen, the nurse midwifery practices around here, faculty practice included, acts more like the OB practices in that they share a pool of patients and the patient is rotated through a group of providers, midwives and OBs included, so that by the time she delivers, she has met each provider in the practice at least once before they deliver/catch her baby. How, then, can we say that we, nurse-midwives, are providing continuity of care when we do not really follow each patient from prenatal to labor to birth to post-partum?" She hemmed and hawed, and said it was still COC because the woman is seeing the same "team" of practitioners for all of her care. Bullshit.
Tell the truth.
WE ARE NOT PROVIDING CONTINUITY OF CARE WHEN WE PRACTICE IN THIS WAY except for maybe, m a y b e, when there are only two providers sharing the load and the woman see these two providers back and forth, similar to midwifery care provided with back up OB care for emergencies...We know the benefits of these kinds of set ups for the provider: you can be a midwife and still maintain some semblance of a personal life because you will not be on call very often. You do shift work, you catch whoevers baby comes while you're on shift at the hospital...whether you've ever met her or not. And in the case of our professor, who only does intrpartum work, almost all of the patients she delivers are women she has NEVER met. This was not something she hid from us, she said it upfront and discussed the challenges with this (since this is likely to be the case for us this semester as well) but what I was getting at was we need to use truthful language, and not use the midwifery's legacy, herstory, as an equivalent to what we're doing now, as nurse midwives. This is crucial because once we allow ourselves to call catching the baby of a woman we've never met "continuity of care," we start down this slippery slope that leads to us calling unnecessary interventions necessary, or making routine ways of caring in the hospital setting equivalent to original midwifery ways of caring. There's a difference, a big difference, and we need to call these differences out, front and center, other wise, the country will just have a new profession of OBGYNs who "don't do c-sections." (ie: we do not have to do what everyone else is doing, in fact it is dangerous)
More examples: We were talking about monitoring using the machine, vs intermittent monitoring. The professor said that the women we care for at the hospital do not have to be hooked up to the external monitors (which makes it impossible to move around because the machine is set up next to the bed, with cords that keep you right there in bed)...that there is policy in place for us to use intermittent monitoring (which means instead of keeping a monitor on 24hrs straight, you can just check the baby's heart tones every 15 to 30 mins wherever the woman happens to be (in the bathroom, on the floor, walking, kneeling, rocking whatever). The professor made this seem common place. When, in fact, in truth, in all my shifts on labor and birth, I have never seen a woman who was not hooked up to the monitor...I have never seen intermittent auscultation practiced! I mentioned this, and then asked for a role play scenario of what we, as student midwives, can do and say to make sure we use this way of monitoring on the floor. "What conversation is had, when, and how, in order to use this practice?" She had no answer. She said "you'll see." But the truth is, I've had a shift with her already, and I know she doesn't do this, neither do any of the other midwives I've worked with on that floor...and I just did two shifts about a week ago! When we do not present the reality, we make it so much harder for ourselves.
I would prefer you, the one who's supposed to be teaching me, to tell me that you argue with folks on the floor about being able to use certain skills and avoiding interventions....that the way to make sure my patient gets appropriate care is to argue this way, vs that way...that this argument for why she doesn't need pitocin is much more effective than that argument...that the way to slow down the ticking clock to c-section is to... These are the conversations, role play scenarios that are more helpful, more truthful, than "midwives believe in decreasing interventions"...yeah ok, of course they do, but how can I do that in the constraints of the setting I'm placed in? And let's talk about how we can claim that we don't believe in unnecessary interventions, and still do all of these interventions...this is a big. damn. deal. if you ask me...conflict of morals, and all...why did I learn how to cut and repair an episiotomy and 1st, 2nd, and 3rd degree tears BEFORE I learned how to prevent the need for such by protecting or hands off of the perineum? What you teach first and why has to have meaning...because what we learn first and why, has an effect on our practice, young moldable minds, we are...and I think we're supposed to learn about these contradictions at "home," meaning among ourselves...with other kinds of midwives, not just nurse-midwives, not in that indoor vs. outdoor conversation sort of way, but in that how can we discuss what's outside, if we aren't willing to deal with what's happening inside our own midwifery community?
This is on my mind for real folks because when people purposely choose to turn away from OB medicalized care (I'm not including those who haven't made the choice but rather were just sent to us, right now) they are expecting to be served in the ways that we claim to serve. Look at what they want...can we provide this? Are we providing this? (It's important to note that there is a difference between the types of midwives and the care they choose/or are limited to providing) but even if it's not homebirth, are we doing what we say we do?
I know I'm not the first one to talk about this, but it seems like a conversation that isn't really being given the consideration it deserves, especially in the classroom.
First, let me say, I am exhausted.
But my class schedule this semester (the halfway point of the program) is better than last semester (thank you universe ;o):
Antepartum (prenatal care)
Intrapartum (labor and birth)/Postpartum
Advanced Pharmacology
Midwifery Pharmacology
Research Seminar
Main Midwifery Books this semester:
Varney's Midwifery
Human Labor and Birth (Oxorne & Foote)
William's Obstetrics
A Fetal Heart Monitoring Guide
Articles, articles, and more articles!
My schedule: Class two days a week (after intensives which is two-three weeks of all day classes five days a week), antepartum clinical two days a week (2 short days of prenatal clinics at the local community women's center - I LOVE my site!), and call once or twice per week! A heavy load, but exciting.
Skills learned this week:
Suturing (which I love, but of course hope I don’t have to do). Belly tales has a post about her first day of suturing, which describes the purpose and anxiety, and then she has an awesome pictorial post about the process of learning it. These are great posts so I don't feel the need to repeat. We also practiced on boneless, skinless chicken thighs to approximate flesh which is, of course, harder than foam! Also, she alluded to the items being provided for them...we had to buy everything. (The foam, chicken, instruments, and sutures...look for medical discount supplies online, and buy expired sutures which are much cheaper for practice. There is absolutely no need to buy expensive stuff because you will not be using these for anything other than practice - the hospital stocks the instruments, you can not bring your own!...But, of course, if you are going to be doing homebirthing, then YES you will need to buy good stuff since you'll be using it for more than practice...but hopefully not often) Along with suturing, you learn how to cut an episiotomy.
Venipuncture. They sprung this one on us. I was not amused. Maybe on Tuesday or so, she said “and Friday you will be learning to draw blood and start IVs…on eachother.” Ugh. Talk about anxiety. I managed to find the vein and poke my partner but as soon as I hit resistance, I pulled the needle right back out, scared, LOL. No IV insertion for me that day. In my defense though, my partner was so damn jumpy and nervous and tense. I did get blood flow though when I removed the needle, which means I was in the vein and that was enough for me. She did a stick on my hand, and it went fine despite the fact that I hated it.
Cardinal movements of labor. This was done with my partner and I taking turns being on the hospital bed, legs wide the hell open in lithotomy position with a fake baby on our bellies or under your shirt that you push out while she practices hand maneuvering and the teacher turns the baby's head to mimic the head positions of birth. She preferred for people to hold her legs back for her turn, I said just give me the stirrups for mine...that leg holding stuff is too intimate for me with people I don't really want all up in my space. Not the most fun activities this week, *sigh.* Now I will have to read the chapters and memorize the mechanisms (ie:cardinal movements) before my first day/night of call.
Vaginal exams. (sterile speculum exams, and how to check for dilatation in centimeters)
Leopold's Maneuvers. To determine size, position, etc. of baby inside the woman's pelvis. (Photo)
Fetal Scalp electrode. Where it goes, why we use it, and how to put it in...all demonstrated on a pelvis model.
Intrauterine catheter. Again, where, why, how.
Pudendal Block. When, where, how and why.
There's probably more, but I'm tired of talking about it. We also practiced sterile gowning and gloving for birth. The didactic content included everything that goes along with the above skills, and topics such as genetic counseling, intermittent auscultation guidelines, etc. A doula also came in to talk about her role as doula and about labor support techniques. It was a loooong week. And those were just the midwifery classes.
Now, on to other things...
One of the things that struck me this week was how medical midwifery education is for the CNM. Now, of course, this was not news to me, I researched all of this before selecting a program, and I'm well aware of the whole "medwife" thing floating around. But it's still...odd...how we learn midwifery in this setting...even knowing it would be medical, I am still shocked by just how medical it is. But more than that, it was a long week of frustration in terms of how we refuse to tell ourselves the truth about the kind of care we provide. For example: We were having a conversation about continuity of care. Continuity of care is simply the woman having the same provider for her whole pregnancy, or even including pre-conception, and her labor and birth and post partum check up. Our professor kept mentioning this continuity of care that we are providing as midwives. Eventually I had to ask (it was irking me) "is there a definition...a statement from the ACNM discussing the definition...of continuity of care that we are using to determine whether or not we are really providing continuity of care (COC)?" She didn't really answer that, but she re-iterated what COC was. So then I had to make a statement leading into another question: "As far as I've seen, the nurse midwifery practices around here, faculty practice included, acts more like the OB practices in that they share a pool of patients and the patient is rotated through a group of providers, midwives and OBs included, so that by the time she delivers, she has met each provider in the practice at least once before they deliver/catch her baby. How, then, can we say that we, nurse-midwives, are providing continuity of care when we do not really follow each patient from prenatal to labor to birth to post-partum?" She hemmed and hawed, and said it was still COC because the woman is seeing the same "team" of practitioners for all of her care. Bullshit.
Tell the truth.
WE ARE NOT PROVIDING CONTINUITY OF CARE WHEN WE PRACTICE IN THIS WAY except for maybe, m a y b e, when there are only two providers sharing the load and the woman see these two providers back and forth, similar to midwifery care provided with back up OB care for emergencies...We know the benefits of these kinds of set ups for the provider: you can be a midwife and still maintain some semblance of a personal life because you will not be on call very often. You do shift work, you catch whoevers baby comes while you're on shift at the hospital...whether you've ever met her or not. And in the case of our professor, who only does intrpartum work, almost all of the patients she delivers are women she has NEVER met. This was not something she hid from us, she said it upfront and discussed the challenges with this (since this is likely to be the case for us this semester as well) but what I was getting at was we need to use truthful language, and not use the midwifery's legacy, herstory, as an equivalent to what we're doing now, as nurse midwives. This is crucial because once we allow ourselves to call catching the baby of a woman we've never met "continuity of care," we start down this slippery slope that leads to us calling unnecessary interventions necessary, or making routine ways of caring in the hospital setting equivalent to original midwifery ways of caring. There's a difference, a big difference, and we need to call these differences out, front and center, other wise, the country will just have a new profession of OBGYNs who "don't do c-sections." (ie: we do not have to do what everyone else is doing, in fact it is dangerous)
More examples: We were talking about monitoring using the machine, vs intermittent monitoring. The professor said that the women we care for at the hospital do not have to be hooked up to the external monitors (which makes it impossible to move around because the machine is set up next to the bed, with cords that keep you right there in bed)...that there is policy in place for us to use intermittent monitoring (which means instead of keeping a monitor on 24hrs straight, you can just check the baby's heart tones every 15 to 30 mins wherever the woman happens to be (in the bathroom, on the floor, walking, kneeling, rocking whatever). The professor made this seem common place. When, in fact, in truth, in all my shifts on labor and birth, I have never seen a woman who was not hooked up to the monitor...I have never seen intermittent auscultation practiced! I mentioned this, and then asked for a role play scenario of what we, as student midwives, can do and say to make sure we use this way of monitoring on the floor. "What conversation is had, when, and how, in order to use this practice?" She had no answer. She said "you'll see." But the truth is, I've had a shift with her already, and I know she doesn't do this, neither do any of the other midwives I've worked with on that floor...and I just did two shifts about a week ago! When we do not present the reality, we make it so much harder for ourselves.
I would prefer you, the one who's supposed to be teaching me, to tell me that you argue with folks on the floor about being able to use certain skills and avoiding interventions....that the way to make sure my patient gets appropriate care is to argue this way, vs that way...that this argument for why she doesn't need pitocin is much more effective than that argument...that the way to slow down the ticking clock to c-section is to... These are the conversations, role play scenarios that are more helpful, more truthful, than "midwives believe in decreasing interventions"...yeah ok, of course they do, but how can I do that in the constraints of the setting I'm placed in? And let's talk about how we can claim that we don't believe in unnecessary interventions, and still do all of these interventions...this is a big. damn. deal. if you ask me...conflict of morals, and all...why did I learn how to cut and repair an episiotomy and 1st, 2nd, and 3rd degree tears BEFORE I learned how to prevent the need for such by protecting or hands off of the perineum? What you teach first and why has to have meaning...because what we learn first and why, has an effect on our practice, young moldable minds, we are...and I think we're supposed to learn about these contradictions at "home," meaning among ourselves...with other kinds of midwives, not just nurse-midwives, not in that indoor vs. outdoor conversation sort of way, but in that how can we discuss what's outside, if we aren't willing to deal with what's happening inside our own midwifery community?
This is on my mind for real folks because when people purposely choose to turn away from OB medicalized care (I'm not including those who haven't made the choice but rather were just sent to us, right now) they are expecting to be served in the ways that we claim to serve. Look at what they want...can we provide this? Are we providing this? (It's important to note that there is a difference between the types of midwives and the care they choose/or are limited to providing) but even if it's not homebirth, are we doing what we say we do?
I know I'm not the first one to talk about this, but it seems like a conversation that isn't really being given the consideration it deserves, especially in the classroom.
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